MacKinnon D F, McMahon F J, Simpson S G, McInnis M G, DePaulo J R
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Biol Psychiatry. 1997 Jul 15;42(2):90-5. doi: 10.1016/S0006-3223(96)00299-5.
If bipolar disorder is genetically heterogeneous, it may be possible to discern clinically heterogeneous familial subtypes based on differential risk for psychiatric comorbidity, for example panic disorder. We evaluated 528 members of 57 families ascertained for a genetic linkage study of bipolar disorder. Families were assorted according to the panic disorder diagnosis of the bipolar proband; the rates of panic and other disorders in relatives were compared. Eighty-eight percent of the 41 subjects with panic disorder had bipolar disorder. Panic disorder was diagnosed in 18% of family members with bipolar disorder. Ten of 57 bipolar probands had panic disorder. Their bipolar first-degree relatives had a significantly higher prevalence of panic disorder, bipolar II, cyclothymia, and dysthymia, but had lower prevalence of substance abuse than the relatives of the bipolar probands without panic disorder. These findings suggest the testable hypothesis that comorbid panic disorder is a marker of genetic heterogeneity in bipolar disorder.
如果双相情感障碍具有遗传异质性，那么基于例如惊恐障碍等精神共病的不同风险，有可能辨别出临床异质性的家族亚型。我们评估了57个因双相情感障碍的遗传连锁研究而确定的家族中的528名成员。根据双相情感障碍先证者的惊恐障碍诊断对家族进行分类；比较亲属中惊恐障碍和其他障碍的发生率。41名患有惊恐障碍的受试者中有88%患有双相情感障碍。双相情感障碍家族成员中有18%被诊断为惊恐障碍。57名双相情感障碍先证者中有10名患有惊恐障碍。他们的双相情感障碍一级亲属中，惊恐障碍、双相II型障碍、环性心境障碍和恶劣心境障碍的患病率显著更高，但物质滥用的患病率低于没有惊恐障碍的双相情感障碍先证者的亲属。这些发现提示了一个可检验的假设，即共病的惊恐障碍是双相情感障碍遗传异质性的一个标志。
